Adult Dosing
Corticosteroid responsive diseases
- Initial dose: 4-48 mg PO divided daily-qid
- Taper the dose in small decrements at appropriate time intervals until adequate clinical response is reached
- Maintenance dose: Use the lowest effective dose
Multiple Sclerosis
- 160 mg PO daily x 1 wk, followed by 64 mg PO qod x 1 month
Poorly controlled, moderate-to-severe asthma
- 40-60 mg PO divided daily-bid x 3-10 days, until peak expiratory flow (PEF) of 80% is achieved and until symptoms resolve
Severe asthma
- 7.5-60 mg PO daily or every other day
- Use the lowest effective dose for long term therapy
Acute asthma
- 40-80 mg divided daily-bid, until PEF of 70% is achieved
Note:
- The dosage requirement are variable and individualized on the basis of the diseases and the response of the patients
- After long term therapy taper the dose gradually to withdraw the drug
Goodpastures syndrome [Non-FDA Approved]
- 1 mg/kg/day PO divided q6-12 hours
Pediatric Dosing
Corticosteroid responsive diseases
- 0.117-1.66 mg/kg or 3.3-50 mg/m2 PO divided tid-qid
Poorly controlled, moderate-to-severe asthma (
11 yrs)
- Children
11 yrs: 1-2 mg/kg/day PO divided daily to bid x 3-10 days; Max: 60 mg/day - Children 12 yrs: 0-60 mg/day PO divided daily to bid x 3-10 days, until peak expiratory flow (PEF) of 80% is achieved and until symptoms resolve
Acute asthma
- Children <11 yrs: 1-2 mg/kg/day divided bid; Max: 60 mg
- Children 12 yrs: 40-80 mg/day divided daily to bid, until PEF of 70% is achieved
Severe asthma (>12 yrs)
- 7.5-60 mg PO daily to every other day
- Use the lowest effective dose for long term therapy
Note:
- The dosage requirement are variable and individualized on the basis of the diseases and the response of the patients
- After long term therapy taper the dose gradually to withdraw the drug
Goodpastures syndrome [Non-FDA Approved]
- 1-2 mg/kg/day PO divided q6-12 hours
[Outline]
- Increase the dose of rapidly acting corticosteroids if the patients on corticosteroid therapy subjected to unusual stress
- Corticosteroid mask the sign of infection and new infections can appear during their use and also there is decrease in resistance and inability to localize infection
- Prolong use of corticosteroid causes posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, secondary ocular infections due to fungi or viruses
- When using methylprednisolone in pregnancy, nursing mothers or women of child-bearing potential the possible benefits of the drug are weighed against the potential hazards to the mother and embryo or fetus. Monitor the infants born to the mothers who have received substantial doses of corticosteroids during pregnancy for the for signs of hypoadrenalism
- Higher dose of hydrocortisone or cortisone increases the blood pressure, salt and water retention, and increases excretion of potassium. Restrict the dietary salt and potassium supplement
- Live or live attenuated vaccines are contraindicated in patients receiving immunosuppressive doses of corticosteroids, killed or inactivated vaccines can be used but the response to such vaccines may be diminished. Indicated immunization procedures can be undertaken in patients receiving nonimmunosuppressive doses of corticosteroids
- Restrict the use of methylprednisolone in fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen. Closely monitor the patient when it is used in latent tuberculosis or tuberculin reactivity, as reactivation of the disease can occur
- Use of corticosteroid can suppress the immune system and thus increase the susceptibility to infections like chickenpox and measles, hence particular care should be taken to avoid exposure in these patients
- If exposed to chickenpox, give prophylaxis with varicella zoster immune globulin (VZIG). If exposed to measles, give prophylaxis with pooled intramuscular immunoglobulin (IG) and consider antiviral treatment if chickenpox develops
- Use cautiously in patient with known or suspected Strongyloides (threadworm) infestation, as immunosuppression due to corticosteroid can lead to strongyloides hyperinfection and dissemination with widespread larval migration, accompanied by severe enterocolitis and potentially fatal gram-negative septicemia
- Rapid withdrawal of corticosetroids may cause secondary adrenocortical insufficiency this may be minimized by gradual reduction of dosage. If stress situation occur reinstitute hormone therapy, administer salt and/or a mineralocorticoid concurrently
- Enhanced effect of corticosteroids is seen when used in patients with hypothyroidism and cirrhosis
- Use cautiously in patients with ocular herpes simplex, as it can cause corneal perforation
- Corticosteroids can cause psychic derangements ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations, also aggravate emotional instability or psychotic tendencies
- Monitor growth and development of infants and children on prolonged corticosteroid therapy
- Corticosteroid therapy can cause Kaposi's sarcoma, discontinuation of therapy can result in clinical remission
- Depending upon risk/benefit decision should be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used
Cautions: Use cautiously in
- Severe renal impairment
- Severe hepatic impairment
- Tuberculosis, latent or active
- Ulcerative colitis
- Abscess or other pyogenic infection
- Cirrhosis
- Intestinal anastomoses
- Diverticulitis
- Peptic ulcer disease
- Hypertension
- Osteoporosis
- Myasthenia gravis
- Psychiatric disorder
- Ocular herpes simplex
- Hypothyroidism
- Cirrhosis
- Active infection
- Diabetes Mellitus
- Cardiovascular disease
- Immunocompromised patients
Pregnancy Category:C
Breastfeeding: Limited data indicates very low levels of methylprednisolone is produced in milk following the maternal dose of upto 8 mg and is not expected to cause any adverse effects in breastfed infants. Avoiding the breastfeeding for 3-4 hrs after high maternal dose decreases the dose received by the infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin /sis/htmlgen?LACT last accessed 27 April 2011). Manufacturer advises that the possible benefits of the drug be weighed against the potential hazards to the infant.
US Trade Name(s)
US Availability
methylprednisolone (generic)
Medrol
Canadian Trade Name(s)
Canadian Availability
Medrol
UK Trade Name(s)
UK Availability
Medrone
Australian Trade Name(s)
Australian Availability
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Medrol 8 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $65.99
90 mg = $185.96 - Medrol 16 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $102.99
90 mg = $299.96 - MethylPREDNISolone 16 MG TABS [Bottle] (CADISTA)
50 mg = $147
150 mg = $419.98 - Medrol 32 MG TABS [Bottle] (PFIZER U.S.)
25 mg = $127.99
75 mg = $367.97 - Medrol 4 MG TABS [Bottle] (PFIZER U.S.)
25 mg = $44.7
75 mg = $122.64 - MethylPREDNISolone 8 MG TABS [Bottle] (CADISTA)
25 mg = $51.99
75 mg = $139.97 - Medrol (Pak) 4 MG TABS [Disp Pack] (PFIZER U.S.)
21 mg = $39.3
63 mg = $104.81
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
